Use of white cell count, age, and presence of other injuries in stratifying risk of intracranial injury in pediatric trauma.
Use of white cell count, age, and presence of other injuries in stratifying risk of intracranial injury in pediatric trauma.
复制标题
使用白色细胞计数、年龄和其他损伤对小儿创伤颅内损伤风险进行分层。
DOI：
10.1136/jim-2020-001509
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发表时间：
2021-03
期刊：
影响因子：
--
通讯作者：
Ngo TL
中科院分区：
文献类型：
--
作者：
Peyton MA;Kouo T;Scott J;Yanek LR;Ngo TL
儿科急救应用研究网络(PECARN)头部损伤/创伤算法是一种经过充分验证的决策规则，用于识别可能不需要头部CT的临床重要创伤性脑损伤风险较低的患者。在轻度颅脑损伤的成人患者中，血糖升高和白细胞计数(WCC)升高与头颅CT异常相关。目前，在儿科患者中不考虑葡萄糖或WCC。这项研究的目的是确定血糖升高或WCC升高是否可以作为额外的工具来对儿童创伤患者的颅内损伤(ICI)进行风险分层。数据摘自马里兰州创伤登记处和约翰霍普金斯儿童中心2017至2020年间患者的电子医疗记录。我们评估了145次符合纳入标准的遭遇。CT显示ICI 33例。除了较高的中位血糖和WCC外，我们还发现，与没有ICI的患者相比，ICI患者的中位年龄更小，也不太可能有其他临床上显著的损伤。多因素Logistic回归分析显示，腰腿痛(OR 1.113.0 5，95%CI 1.0 2~1.2 1)、年龄较小(OR 0.89，95%CI 0.8~0.98)、无其他损伤(OR 0.4 1，95%CI 0.2 3~0.73)是脑梗塞的危险因素。对于我们的模型，曲线下的面积是0.79。当与PECARN算法一起使用时，我们的模型可以帮助确定哪些患者可以避免头部CT或接受较短的观察期。
The Pediatric Emergency Care Applied Research Network (PECARN) Head Injury/Trauma Algorithm is a well-validated decision rule used to identify patients at low risk of clinically important traumatic brain injuries who may not need head CT. In adult patients with mild head trauma, elevated serum glucose and white cell count (WCC) have been associated with abnormal head CT findings. Currently, glucose or WCC is not considered in pediatric patients. The objective of this study was to determine if elevations in glucose or WCC could be used as additional tools to risk-stratify pediatric trauma patients for intracranial injury (ICI). Data were abstracted from the Maryland Trauma Registry and from electronic medical records for patients at the Johns Hopkins Children’s Center from 2017 to 2020. We evaluated 145 encounters that met the inclusion criteria. There were 33 cases of ICI on CT. In addition to higher median glucose and WCC, we found that patients with ICI had a younger median age and were less likely to have other clinically significant injuries than patients without ICI. Following multiple logistic regression analysis, WCC (OR 1.113, 95% CI 1.02 to 1.21), younger age (OR 0.89, 95% CI 0.8 to 0.98), and absence of other injuries (OR 0.41, 95% CI 0.23 to 0.73) were found to be associated with risk of ICI. The area under the curve for our model was 0.79. When used with the PECARN algorithm, our model could help determine which patients may avoid head CT or undergo a shorter observation period.
影响因子：
168.9
作者：
Kuppermann, Nathan;Holmes, James F.;Wootton-Gorges, Sandra L.
通讯作者：
Wootton-Gorges, Sandra L.
影响因子：
6.2
作者：
Easter, Joshua S.;Bakes, Katherine;Haukoos, Jason S.
通讯作者：
Haukoos, Jason S.
影响因子：
26.1
作者：
Miglioretti, Diana L.;Johnson, Eric;Williams, Andrew;Greenlee, Robert T.;Weinmann, Sheila;Solberg, Leif I.;Feigelson, Heather Spencer;Roblin, Douglas;Flynn, Michael J.;Vanneman, Nicholas;Smith-Bindman, Rebecca
通讯作者：
Smith-Bindman, Rebecca